Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9

• Published in: Pain medicine (Malden, Mass.) Mass.), 2019-01, Vol.20 (1), p.113-118
• Main Authors: McCaffrey, Stacey A, Black, Ryan A, Villapiano, Albert J, Jamison, Robert N, Butler, Stephen F
• Format: Article
• Language: English
• Subjects: Care and treatment; Chronic pain; Classification; Drug abuse; Narcotics; Opioid abuse; Opioids; Pain; Physicians; Urine
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx311

Abstract Objective The Current Opioid Misuse Measure (COMM) is a commonly used self-report instrument to identify and monitor aberrant opioid-related behavior in chronic pain patients on opioid therapy. However, the length of the COMM may limit its clinical utility. Additionally, this paper-and-pencil screener requires hand scoring, which increases paperwork and staff burden. Therefore, the current study presents development of the “COMM-9,” a brief electronically administered form of the COMM. Methods Patients (N = 517) with chronic noncancer pain on opioid therapy completed the COMM. Patients were classified as either being positive or negative for aberrant drug-related behavior based on self-report data from a structured interview, physician-report data, and urine toxicology screen (the Aberrant Drug Behavior Index [ADBI]). COMM items with the strongest classification accuracy were identified using the LASSO method as the selection criterion in conjunction with the leave-one-out cross-validation method as the stop criterion. A sub-set of patients (n=55) completed a second administration of the COMM one week later to evaluate test-retest reliability. Results Nine items were identified before the selection criterion stopped, and logistic regression was utilized to predict probabilities of positive ADBI from the 9 COMM items using all data and the cross-validation procedure. Receiver operating characteristic curves revealed high levels of classification accuracy that were essentially equivalent to the full COMM. Cut-points were identified to classify patients as having no/low risk, moderate risk, and high risk for aberrant opioid-related behavior. Test-retest reliability of the COMM-9 was comparable to the full 17-item COMM. Conclusions This study presents the successful development of a brief electronic screener to identify current aberrant opioid-related behavior in chronic pain patients on long-term opioid therapy.